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Yang M, Liu Y, Miura KW, Matsumoto M, Jiao D, Zhu Z, Li X, Cui M, Zhang J, Qian M, Huang L, Anme T. Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study. BMC Public Health 2024; 24:2141. [PMID: 39113011 PMCID: PMC11304620 DOI: 10.1186/s12889-024-19697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/06/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults. METHODS We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs). RESULTS At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%. CONCLUSION Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.
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Affiliation(s)
- Mengjiao Yang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery. Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yang Liu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | | | | | - Dandan Jiao
- Department of Nursing, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhu Zhu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- School of Nursing, Hangzhou Normal University, Hangzhou, 311121, China
| | - Xiang Li
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- College of Child Development and Education, Zhejiang Normal University, Hangzhou, 311231, China
| | - Mingyu Cui
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Jinrui Zhang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Meiling Qian
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Lujiao Huang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Clinical Nutrition, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 3058577, Japan.
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Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants. Expert Opin Drug Saf 2024:1-7. [PMID: 39105534 DOI: 10.1080/14740338.2024.2385479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/22/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults' profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use. RESEARCH DESIGN AND METHODS A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use. RESULTS A 8.9% (95% CI 0.074-0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115-1.234), diagnoses of depression (OR 2.889, 95% CI 1.785-4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003-2.729). CONCLUSIONS This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.
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Affiliation(s)
- Daniela A Rodrigues
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
- PhD Student, University of Salamanca, Salamanca, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela/IDIS), A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Fátima Roque
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
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O'Mahony C, Dalton K, O'Hagan L, Murphy KD, Kinahan C, Coyle E, Sahm LJ, Byrne S, Kirke C. Economic cost-benefit analysis of person-centred medicines reviews by general practice pharmacists. Int J Clin Pharm 2024; 46:957-965. [PMID: 38814513 PMCID: PMC11286700 DOI: 10.1007/s11096-024-01732-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Medicines reviews by general practice pharmacists improve patient outcomes, but little is known about the associated economic outcomes, particularly in patients at higher risk of medicines-related harm. AIM To conduct an economic cost-benefit analysis of pharmacists providing person-centred medicines reviews to patients with hyperpolypharmacy (prescribed ≥ 10 regular medicines) and/or at high risk of medicines-related harm across multiple general practice settings. METHOD Service delivery costs were calculated based on the pharmacist's salary, recorded timings, and a general practitioner fee. Direct cost savings were calculated from the cost change of patients' medicines post review, projected over 1 year. Indirect savings were calculated using two models, a population-based model for avoidance of hospital admissions due to adverse drug reactions and an intervention-based model applying a probability of adverse drug reaction avoidance. Sensitivity analyses were performed using varying workday scenarios. RESULTS Based on 1471 patients (88.4% with hyperpolypharmacy), the cost of service delivery was €153 per review. Using the population-based model, net cost savings ranging from €198 to €288 per patient review and from €73,317 to €177,696 per annum per pharmacist were calculated. Using the intervention-based model, net cost savings of €651-€741 per review, with corresponding annual savings of €240,870-€457,197 per annum per pharmacist, were calculated. Savings ratios ranged from 181 to 584% across all models and inputs. CONCLUSION Person-centred medicines reviews by general practice pharmacists for patients at high risk of medicines-related harm result in substantial cost savings. Wider investment in general practice pharmacists will be beneficial to minimise both patient harm and healthcare system expenditure.
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Affiliation(s)
- Cian O'Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Leon O'Hagan
- Primary Care, Community Healthcare Organisations 1 and 8, Health Service Executive, Dublin, Ireland
| | - Kevin D Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Clare Kinahan
- Primary Care, Community Healthcare Organisations 1 and 8, Health Service Executive, Dublin, Ireland
| | - Emma Coyle
- Primary Care, Community Healthcare Organisations 1 and 8, Health Service Executive, Dublin, Ireland
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Ciara Kirke
- National Quality and Patient Safety Directorate, Health Service Executive, Dublin, Ireland
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Sezgin D, Petrovic M, Canavan M, Gonzales GB, Torsy T, Holloway S, Fletcher J, Fourie A, Geraghty J, Neachtain MN, Delaney E, Muntlin Å, McElvaney A, Oda K, Lang D, Karadağ A, Gethin G, Probst S, Beeckman D. Prevention of pressure ulcers from the perspective of frailty, pre-frailty, and health and social inequalities: An opinion paper. J Tissue Viability 2024:S0965-206X(24)00111-6. [PMID: 39127579 DOI: 10.1016/j.jtv.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
| | - Michelle Canavan
- School of Medicine, University of Galway, Galway, Ireland; Health Service Executive, Ireland.
| | | | - Tim Torsy
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | | | - Jacqui Fletcher
- Clinical Lead Pressure Ulcers, National Wound Care Strategy Programme, NHS England, United Kingdom.
| | - Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | - Jemell Geraghty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | | | | | - Åsa Muntlin
- Department of Medical Sciences/Clinical Epidemiology and Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Uppsala, Sweden; College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Aideen McElvaney
- School of Nursing and Midwifery, University of Galway, Galway, Ireland.
| | - Keiko Oda
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Deirdre Lang
- Health Service Executive, Ireland; School of Nursing & Midwifery Royal College of Surgeons in Ireland (RCSI), Ireland.
| | - Ayişe Karadağ
- School of Nursing, Koç University, Istanbul, Turkey.
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland.
| | - Sebastian Probst
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Sweden.
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Alamri SH, Mealif HM. Exploring the correlates of frailty among hospitalized older adults: A cross-sectional study in a Saudi teaching hospital. Medicine (Baltimore) 2024; 103:e38603. [PMID: 38905424 PMCID: PMC11191950 DOI: 10.1097/md.0000000000038603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024] Open
Abstract
Frailty is an important public health concern associated with aging. It increases the risk of adverse clinical outcomes, such as falls, late-life dependency, hospitalization, disability, and mortality. The objectives of this study were to estimate the prevalence of frailty and to identify factors associated with frailty among older adults (≥65 years) admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This cross-sectional study was conducted at King Abdulaziz University Hospital. The data were collected during the months of January and February 2022 and included demographic characteristics, comorbidities, length of stay, and hospital mortality. Frailty status of participants was assessed using the Clinical Frailty Scale. A total of 147 patients (aged ≥ 65 years) were included in our study. The prevalence rates of frailty and non-frailty were 71.4% and 28.6%, respectively. Frail patients had higher comorbidity index (P = .003), polypharmacy (P = .003), heart failure (P = .001), and prolonged hospital stays (P = .007). The results of the multiple logistic regression revealed that the tall patients had a lower risk of frailty (odds ratio = 0.0089, 95% confidence interval: 0.0001-0.7588, P = .042) and patients with higher comorbidity indexes had higher risk of frailty (odds ratio = 1.4907, 95% confidence interval: 1.1449-1.9927, P = .004). In this study, more than two-thirds of the hospitalized older patients were classified as frail. High comorbidity index, heart failure, and polypharmacy were strong predictors of frailty. Patients with frailty were more likely to have a prolonged hospital stay than those without frailty. Therefore, early detection of frailty and proper intervention are essential for improving health outcomes in this vulnerable population.
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Affiliation(s)
- Sultan H. Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Neuroscience and Geroscience Research Unit, King Fahd Medical Research Center, Abdulaziz University, Jeddah, Saudi Arabia
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hetaf M. Mealif
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Polypharmacy Management in Chronic Conditions: A Systematic Literature Review of Italian Interventions. J Clin Med 2024; 13:3529. [PMID: 38930058 PMCID: PMC11204469 DOI: 10.3390/jcm13123529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. Results: After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% (n = 7) were observational studies, 11% (n = 1) were experimental studies, and 11% (n = 1) were two-phase studies. A total of 44% (n = 4) of the studies involved patients aged ≥ 65 years, while 56% (n = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; n = 6). Outcomes were mainly related to levels of polypharmacy (29%; n = 6) and comorbidities (29%; n = 6), effectiveness rates (14%; n = 3), and avoidable costs (9%; n = 2). Conclusions: This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden.
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Affiliation(s)
- Lara Perrella
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Sara Mucherino
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy;
- IRCCS MultiMedica Hospital, Sesto S. Giovanni, 20099 Milan, Italy
| | - Maddalena Illario
- Division of Health Innovation, Campania Region Health Directorate, 80143 Naples, Italy;
| | - Valentina Orlando
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Enrica Menditto
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
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Lopes De Oliveira T, Tang B, Bai G, Sjölander A, Jylhävä J, Finkel D, Pedersen NL, Hassing LB, Reynolds CA, Karlsson IK, Hägg S. Effects from medications on functional biomarkers of aging in three longitudinal studies of aging in Sweden. Aging Cell 2024; 23:e14132. [PMID: 38426357 PMCID: PMC11296127 DOI: 10.1111/acel.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
Antihypertensive, lipid-lowering, and blood glucose-lowering drugs have slowed down the aging process in animal models. In humans, studies are limited, have short follow-up times, and show mixed results. Therefore, this study aimed to estimate the effects of commonly used medications on functional aging, cognitive function, and frailty. We included information on individuals from three Swedish longitudinal population-based studies collected between 1986 and 2014. Our exposures were the 21 most used groups of medications among individuals aged 65 years and older in the Swedish population in 2022. Functional aging index (n = 1191), cognitive function (n = 1094), and frailty index (n = 1361) were the outcomes of interest. To estimate the medication effects, we used a self-controlled analysis, where each individual is his/her own control, thereby adjusting for all time-stable confounders. The analysis was additionally adjusted for time-varying confounders (chronological age, Charlson Comorbidity Index, smoking, body mass index, and the number of drugs). The participants were 65.5-82.8 years at the first in-person assessment. Adrenergics/inhalants (effect size = 0.089) and lipid-modifying agents/plain (effect size = 0.082) were associated with higher values of cognitive function (improvement), and selective calcium channel blockers with mainly vascular effects (effect size = -0.129) were associated with lower values of the functional aging index (improvement). No beneficial effects were found on the frailty index. Adrenergics/inhalants, lipid-modifying agents/plain, and selective calcium channel blockers with mainly vascular effects may benefit functional biomarkers of aging. More research is needed to investigate their clinical value in preventing adverse aging outcomes.
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Affiliation(s)
- Thaís Lopes De Oliveira
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Neurobiology, Care Sciences and Society, Aging Research CenterKarolinska InstitutetStockholmSweden
| | - Bowen Tang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Ge Bai
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Women's and Children's HealthUppsala UniversitetUppsalaSweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC)University of TampereTampereFinland
| | - Deborah Finkel
- School of Health and Welfare, Institute of GerontologyJönköping UniversityJönköpingSweden
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Linda B. Hassing
- Department of PsychologyUniversity of GothenburgGothenburgSweden
- Centre for Ageing and HealthUniversity of GothenburgGothenburgSweden
| | - Chandra A. Reynolds
- Department of PsychologyThe University of California at RiversideRiversideCaliforniaUSA
- Department of Psychology and NeuroscienceInstitute for Behavioral Genetics, University of Colorado BoulderBoulderColoradoUSA
| | - Ida K. Karlsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Sara Hägg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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Lias N, Lindholm T, Holmström AR, Uusitalo M, Kvarnström K, Toivo T, Nurmi H, Airaksinen M. Harmonizing the definition of medication reviews for their collaborative implementation and documentation in electronic patient records: A Delphi consensus study. Res Social Adm Pharm 2024; 20:52-64. [PMID: 38423929 DOI: 10.1016/j.sapharm.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Medication review practices have evolved internationally in a direction in which not only physicians but also other healthcare professionals conduct medication reviews according to agreed practices. Collaborative practices have increasingly highlighted the need for electronic joint platforms where information on medication regimens and their implementation can be documented, kept updated, and shared. OBJECTIVE The aim of this study was to harmonize the definition of medication reviews and create a unified conceptual basis for their collaborative implementation and documentation in electronic patient records (definition appellation: collaborative medication review). METHODS The study was conducted using the Delphi consensus survey with three interprofessional expert panel rounds in September-December 2020. The consensus rate was set at 80%. Experts assessed the proposed definition of collaborative medication review based on an international and national inventory of medication review definitions. The expert panel (n = 41) involved 12 physicians, 13 pharmacists, 10 nurses, and six information management professionals. The range of response rates for the rounds was 63-88%. RESULTS The experts commented on which of the pre-selected items (n = 75) characterizing medication reviews should be included in the definition of collaborative medication review. The items were divided into the following five themes and 51 of them reached consensus: 1) Actions included in the collaborative medication review (n = 24/24), 2) Settings where the review should be conducted (n = 5/5), 3) Situations where the review should be considered as needed and carried out (n = 10/11), 4) Prioritization of top five benefits to be achieved by the review and 5) Prioritization of top five patient groups to whom the review should be targeted. CONCLUSIONS A strong interprofessional consensus was reached on the definition of collaborative medication review. The most challenging was to identify individual patient groups benefiting from the review.
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Affiliation(s)
- Noora Lias
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Tanja Lindholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Marjo Uusitalo
- Innovation and Development Unit, Istekki Ltd., P.O. Box 4000, FI-70601, Kuopio, Finland; Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland.
| | - Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland; HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland; HUS Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland.
| | - Terhi Toivo
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland; Hospital Pharmacy, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, P.O. Box 272, FI-33101, Tampere, Finland.
| | - Harri Nurmi
- Finnish Medicines Agency Fimea, P.O. Box 55, FI-00034, Fimea, Finland.
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
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Gemikonakli G, Mach J, Tran T, Wu H, Hilmer SN. Probing polypharmacy, ageing and sex effects on physical function using different tests. Fundam Clin Pharmacol 2024; 38:561-574. [PMID: 38247119 DOI: 10.1111/fcp.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ageing, sex and polypharmacy affect physical function. OBJECTIVES This mouse study investigates how ageing, sex and polypharmacy interact and affect grip strength, balance beam and wire hang, correlating and comparing the different test results between and within subgroups. METHODS Young (2.5 months) and old (21.5 months) C57BL/6 J male and female mice (n = 10-6/group) were assessed for physical function at baseline on grip strength, balance beam and wire hang with three trials of 60 s (WH60s) and one trial of 300 s (WH300s). Mice were randomised to control or diet containing a high Drug Burden Index (DBI, total anticholinergic and sedative drug exposure) polypharmacy regimen (metoprolol, simvastatin, citalopram, oxycodone and oxybutynin at therapeutic oral doses). Following 6-8 weeks of treatment, mice were reassessed. RESULTS High DBI polypharmacy and control mice both showed age group differences on all tests (p < 0.05). Only control mice showed sex differences, with females outperforming males on the WH60s and balance beam for old mice, WH300s for young mice (p < 0.05). Polypharmacy reduced grip strength in all subgroups (p < 0.05) and only in old females reduced wire hang time and cumulative behaviour and balance beam time and %walked (p < 0.05). Physical function assessments were all correlated with each other, with differences between subgroups (p < 0.05), and mice within subgroups showed interindividual variability in performance. CONCLUSION Age, sex and polypharmacy have variable effects on different tests, and behavioural measures are useful adjuvants to assessing performance. There was considerable within-group variability in change in measures over time. These findings can inform design and sample size of future studies.
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Affiliation(s)
- Gizem Gemikonakli
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - John Mach
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Trang Tran
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Harry Wu
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
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10
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Komici K, Pansini A, Bencivenga L, Rengo G, Pagano G, Guerra G. Frailty and Parkinson's disease: the role of diabetes mellitus. Front Med (Lausanne) 2024; 11:1377975. [PMID: 38882667 PMCID: PMC11177766 DOI: 10.3389/fmed.2024.1377975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/02/2024] [Indexed: 06/18/2024] Open
Abstract
Parkinson's disease (PD) is a chronic neurodegenerative disease associated with a progressive loss of dopaminergic neurons, clinically characterized by motor and non-motor signs. Frailty is a clinical condition of increased vulnerability and negative health outcomes due to the loss of multiple physiological reserves. Chronic hyperglycemia and insulin resistance, which characterize diabetes mellitus (DM), have been reported to alter dopaminergic activity, increase the risk of PD, and influence the development of frailty. Even though diabetes may facilitate the development of frailty in patients with PD, this relationship is not established and a revision of the current knowledge is necessary. Furthermore, the synergy between DM, PD, and frailty may drive clinical complexity, worse outcomes, and under-representation of these populations in the research. In this review, we aimed to discuss the role of diabetes in the development of frailty among patients with PD. We summarized the clinical characteristics and outcomes of patients with concomitant DM, PD, and frailty. Finally, interventions to prevent frailty in this population are discussed.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS-Scientific Institute of Telese Terme, Telese Terme, BN, Italy
| | - Gennaro Pagano
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center, Basel, Switzerland
- University of Exeter Medical School, London, United Kingdom
| | - Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Park HJ, Thapa N, Bae S, Yang JG, Choi J, Noh ES, Park H. Association between Physical Function, Mental Function and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study. J Clin Med 2024; 13:3207. [PMID: 38892918 PMCID: PMC11172678 DOI: 10.3390/jcm13113207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study examines the relationship between physical and mental function and frailty, independently and in conjunction with polypharmacy, among older adults. Methods: This cross-sectional study consisted of 368 participants aged ≥60 years. The participants were categorized into either robust or frail groups using Fried's frailty phenotype. Physical functions were assessed using grip strength, gait speed, Timed Up and Go (TUG), the Five Chair Sit to Stand Test (FCSST) and the Six-Minute Walk Test (SMWT). Mental functions were assessed using cognitive function and depression. Cognitive function was measured using Mini-Mental State Examination (MMSE). Depression was assessed with the Korean version of the Short Geriatric Depression Scale (SGDS). Results: The mean age of study population was 75.4 years. In this population, we identified 78.8% (n = 290) robust participants and 21.2% (n = 78) frail participants. The study examined frailty status (frail vs. non-frail) and frailty with and without polypharmacy using multivariate logistic regressions, adjusting for age and sex. In the logistic regression model estimating the risk of frailty, after adjustments for age, sex, BMI, and number of medications, individuals with low SMWT showed a significantly increased risk of frailty, with an odds ratio (OR) of 8.66 and a 95% confidence interval (CI) of 4.55-16.48. Additionally, global cognitive function was associated with a 1.97-fold increase in frailty risk (95% CI: 1.02-3.67). Moreover, in models adjusted for age, sex, and BMI to assess frailty risk linked to polypharmacy, the TUG, SMWT, and SGDS all showed increased risks, with ORs of 3.65 (95% CI: 1.07-12.47), 5.06 (95% CI: 1.40-18.32), and 5.71 (95% CI: 1.79-18.18), respectively. Conclusions: Physical function (SMWT, FCSST, TUG) and mental function (depression, cognition) were associated with frailty. By comprehensively examining these factors, we will gain valuable insights into frailty and enable more precise strategies for intervention and prevention.
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Affiliation(s)
| | | | | | | | | | | | - Hyuntae Park
- Department of Healthcare and Science, Dong-A University, Busan 49315, Republic of Korea; (H.-J.P.); (N.T.); (S.B.); (J.-G.Y.); (J.C.); (E.-S.N.)
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12
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Pan N, Ossowski Z, Tong J, Li D, Gao S. Effects of Exercise on Frailty in Older People Based on ACSM Recommendations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:3037. [PMID: 38892748 PMCID: PMC11173309 DOI: 10.3390/jcm13113037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: The objective of the study was to carry out an analysis of the methodological quality of clinical trials (effects of exercise on frailty in older people) based on ACSM recommendations. Methods: The search scope included PubMed, Embase, Web of Science, Cochrane, and literature that cannot be retrieved from the database. The topic was the impact of exercise on frailty in elderly people. Changes in five outcome measures (FP, BI, SPPB, GS, and BMI) were assessed using mean differences (MD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups. Results: The intervention effects of exercise on the five outcome indicators of frailty in elderly people were all significant (p < 0.05). The effect of a high-consistency subgroup on outcome indicators FP and GS was more significant than that of the low- or uncertain-consistency subgroup (MD: -1.09 < -0.11, MD: 2.39 >1.1). There was no significant difference in the intervention effect as reflected in the outcome measures SPPB and BMI in the high-consistency subgroup (p = 0.07, p = 0.34). There was no significant difference in the impact of the intervention on the outcome measure BI between the two subgroups (p = 0.06, p = 0.14). Conclusions: Exercise prescriptions with high consistency with ACSM recommendations may be more effective in both FP and GS interventions than those with uncertain or low consistency. However, it is essential to note that the data derived from the meta-analysis is still subject to the small number of studies, the unknown degree of consistency of participants in individual studies, and the different mix of cases in the studies.
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Affiliation(s)
- Neng Pan
- Faculty of Physical Culture, Akademia Wychowania Fizycznego I Sportu, 80-336 Gdansk, Poland;
| | - Zbigniew Ossowski
- Faculty of Physical Culture, Akademia Wychowania Fizycznego I Sportu, 80-336 Gdansk, Poland;
| | - Jun Tong
- Department of Sport, Kunming Medical University, Kunming 650000, China;
| | - Dan Li
- Academy of Sport, Yunnan Normal University, Kunming 650000, China; (D.L.); (S.G.)
| | - Shan Gao
- Academy of Sport, Yunnan Normal University, Kunming 650000, China; (D.L.); (S.G.)
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Gong Z, Su F, Kang X, Zhong Y, Xie Y. The Influencing Factors of Frailty and Quality of Life in Elderly Patients After Spinal Surgery. Clin Interv Aging 2024; 19:769-778. [PMID: 38751856 PMCID: PMC11094365 DOI: 10.2147/cia.s453830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background To study the related factors of frailty and quality of life in elderly patients after spinal surgery. Methods The anxiety, depression, frailty, and quality of life of all patients were assessed by the Anxiety screening scale (GAD-7), Depression screening scale (PHQ-9), Frailty screening scale (FRAIL), and European five-dimensional health scale (EQ-5D-5L) 1 day before surgery (DAY-0). A numeric rating scale (NRS) was used to evaluate patients' pain during activities on the 1st day (POD-1), 3rd day (POD-3), and 30th day (POD-30) after operation. FRAIL scale and EQ-5D-5L were used to evaluate patients' frailty and quality of life on POD-30 and 90th day (POD-90) after the operation. Results There were significant differences in age, body mass index (BMI), preoperative serum albumin level (ALB), and NRS score on POD-1 between the two groups (P<0.05). Age and PHQ-9 score were positively correlated with EQ-5D-5L score (P<0.05, r Age=0.245, rPHQ-9=0.217), and preoperative ALB level was negatively correlated with EQ-5D-5L score (P<0.05, r ALB=-0.274). Conclusion The older the age, the larger the BMI and the higher the NRS score on the first day after surgery, the more prone to frailty in elderly patients after spinal surgery; The older age and the lower the preoperative ALB level, the worse the quality of life in elderly patients after spinal surgery.
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Affiliation(s)
- Zheng Gong
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Fengzhi Su
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Medical University, Nanning, People’s Republic of China
| | - Xiaoyu Kang
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Yuling Zhong
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Yubo Xie
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Grohmann D, Wellsted D, Mengoni SE. Definition, assessment and management of frailty for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13219. [PMID: 38485891 DOI: 10.1111/jar.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management. METHOD Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities. RESULTS Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management. CONCLUSION Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.
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Affiliation(s)
- Dominique Grohmann
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Silvana E Mengoni
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
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15
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Chen X, Zheng R, Xu X, Wang Z, Huang G, Wu R, Hong J. Frailty and Health-Related Quality of Life in Elderly Patients Undergoing Esophageal Cancer Surgery: A Longitudinal Study. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:125-133. [PMID: 38677471 DOI: 10.1016/j.anr.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE This study aims to elucidate the longitudinal alterations in frailty and health-related quality of life experienced by elderly patients undergoing surgical treatment for esophageal cancer. Additionally, it seeks to ascertain the impact of preoperative frailty on postoperative health-related quality of life over time. METHODS 131 patients were included in the prospective study. Patients' frailty and health-related quality-of-life were assessed utilizing the Tilburg and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at preoperative, 1 week, 1 month, and 3 months, postoperatively. Statistical analyses were performed using generalized estimating equations, repeated-measures analysis of variance, and linear mixed models (LMMs). RESULTS Out of 131 patients, 28.2% had frailty before surgery, and the prevalence of frailty consistently higher after surgery compared with baseline (67.9%, 51.9%, and 39.7%). There was no significant change in frailty scores in preoperative frail patients within 3 months following surgery (p = .496, p < .999, p < .999); whereas in preoperative non-frail patients, the frailty scores increased at 1 week (p < .001) and then decreased at 1 month (p = .014), followed by no change at 3 months. In addition, preoperative frail patients had significantly worse global quality-of-life (β = -4.24 (-8.31; -.18), p = .041), physical functioning (β = -9.87 (-14.59; -5.16), p < .001), role functioning (β = -10.04 (-15.76; -4.33), p = .001), and social functioning (β = -8.58 (-15.49; -1.68), p = .015), compared with non-frail patients. CONCLUSIONS A significant proportion of participants exhibited a high prevalence of preoperative frailty. These patients, who were preoperatively frail, exhibited a marked reduction in health-related quality-of-life, a more gradual recovery across various functional domains, and an increased symptom burden during the follow-up period. Therefore, it is crucial to meticulously identify and closely monitor patients with preoperative frailty for any changes in their postoperative physiology, role, and social functioning.
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Affiliation(s)
- Xi Chen
- School of Nursing, Anhui Medical University, Hefei, China
| | - Rong Zheng
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xiuzhi Xu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Zhuzhu Wang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Guohong Huang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Rongrong Wu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Jingfang Hong
- School of Nursing, Anhui Medical University, Hefei, China.
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16
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Soulis G, Kyriakopoulou E, Leventouri A, Zigkiri E, Efthymiou V, Kentros Z, Koutsouri A. Pilot Testing of Useful Tools' Validity for Frailty Assessment in Greece: Translated PRISMA-7 Tool, Modified Fried Criteria and Clinical Frailty Scale. Healthcare (Basel) 2024; 12:930. [PMID: 38727487 PMCID: PMC11083930 DOI: 10.3390/healthcare12090930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person's health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum-maximum age = 65-95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = -0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = -0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = -0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.
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Affiliation(s)
- George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- Hellenic Society for the Study and Research of Ageing, 10677 Athens, Greece
| | - Efstathia Kyriakopoulou
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Aristea Leventouri
- Department of Neurology, University General Hospital of Patra, 26504 Patra, Greece;
| | - Eleni Zigkiri
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Vasiliki Efthymiou
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Zikos Kentros
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Anastasia Koutsouri
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- 1st Department of Internal Medicine, Henry Dunant Hospital Center, 11526 Athens, Greece
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Liu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. J Clin Med 2024; 13:2382. [PMID: 38673654 PMCID: PMC11050860 DOI: 10.3390/jcm13082382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.
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Affiliation(s)
- Jia Liu
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Yuezhi Zhu
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Jen Kit Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Azera Hasra Ismail
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Roszita Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Nor Haty Hassan
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
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Amitani H, Suzuki H, Kobayashi H, Murayama M, Uto NS, Kuroda E, Kobayashi Y, Kawabe M, Amitani M, Inui A, Marunaka Y. Relationship between the severity of pre-frailty and the degree of adaptation of Ninjin'yoeito (NYT) on pre-frailty. FRONTIERS IN AGING 2024; 5:1304217. [PMID: 38681234 PMCID: PMC11045879 DOI: 10.3389/fragi.2024.1304217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
With the global trend towards longer life expectancies, there's an increasing emphasis on not just living longer, but also maintaining health and wellbeing into older age. This study explores the efficacy of Ninjin'yoeito (NYT) in the early stages of frailty, a critical period for preventive interventions. Taking account of the knowledge gap regarding the association between early frailty and NYT, we use data from workplace health checkups to examine the relationship between pre-frailty severity and NYT adaption. The objective of our research is to enhance the comprehension of early treatments using NYT to prevent the progression of frailty. A total of 314 employees of the Kyoto Industrial Health Association who received workplace health checkups between November 2021 and March 2023 and consented to this study were included in the analysis. Information on gender, age, body mass index (BMI), NYT-specific symptoms assessment, the Japanese version of the General Health Questionnaire-12 (GHQ-12), and the Kihon Checklist (KCL) were obtained. The correlation analysis revealed that there was a strong positive correlation between the number of applicable NYT indications and the GHQ-12 score (r = 0.5992, p < 0.0001). Similarly, a moderate positive correlation was observed between the number of applicable NYT indications and the KCL score (r = 0.5030, p < 0.0001). In the multivariate analysis, both GHQ-12 (β = 0.49, SE = 0.06, t = 7.66, 95% CI: 0.36 to 0.62, p = 0.000) and KCL (β = 0.54, SE = 0.12, t = 4.29, 95% CI: 0.29 to 0.79, p = 0.000) showed significant positive associations with the variance in the number of applicable NYT indications, indicating that higher scores on these measures were related to a greater number of indications. NYT has the potential to be utilized not only as a therapeutic intervention for frailty, but also as a preventive measure.
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Affiliation(s)
- Haruka Amitani
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Division of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hajime Suzuki
- Division of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hironori Kobayashi
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
| | - Masaru Murayama
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
| | - Nanami Sameshima Uto
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Eishi Kuroda
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Momoko Kawabe
- Kampo Research Laboratories, Kracie Pharma, Ltd, Tokyo, Japan
| | - Marie Amitani
- Education Center for Doctors in Remote Islands and Rural Areas, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Division of Community-Based Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akio Inui
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshinori Marunaka
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan
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Mielke N, Barghouth MH, Fietz AK, Villain C, Bothe T, Ebert N, Schaeffner E. Effect modification of polypharmacy on incident frailty by chronic kidney disease in older adults. BMC Geriatr 2024; 24:335. [PMID: 38609867 PMCID: PMC11015642 DOI: 10.1186/s12877-024-04887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults. METHODS In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 and/or an albumin-creatinine ratio ≥ 30 mg/g. Incident frailty was assessed at follow-up using Fried criteria. Logistic regression was applied to assess (1) the association of different polypharmacy definitions with incident frailty and (2) effect modification by CKD. RESULTS In this cohort study, out of 757 non-frail participants (mean age 82.9 years, 52% female, 74% CKD), 298 (39%) participants reported polypharmacy. Over the observation period of 2.1 years, 105 became frail. Individuals with polypharmacy had 1.96 adjusted odds (95% confidence interval (CI): 1.20-3.19) of becoming frail compared to participants without polypharmacy. The effect of polypharmacy on incident frailty was modified by CKD on the additive scale (relative excess risk due to interaction: 1.56; 95% CI 0.01-3.12). CONCLUSIONS This study demonstrates an association of polypharmacy and incident frailty and suggests strong evidence for an effect modification of CKD on polypharmacy and incident frailty. Revision of prescriptions could be a target strategy to prevent frailty occurrence, especially in older adults with CKD.
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Affiliation(s)
- Nina Mielke
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Muhammad Helmi Barghouth
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Cédric Villain
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Service de Gériatrie, Normandie Univ UNICAEN, INSERM U1075 COMETE, CHU de Caen, Caen, France
| | - Tim Bothe
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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20
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Pereira A, Veríssimo M, Ribeiro O. Influence of chronic medical conditions on older patients' willingness to deprescribe medications: a cross-sectional study. BMC Geriatr 2024; 24:315. [PMID: 38575904 PMCID: PMC10993447 DOI: 10.1186/s12877-024-04891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Aging correlates with a heightened prevalence of chronic diseases, resulting in multimorbidity affecting 60% of those aged 65 or older. Multimorbidity often leads to polypharmacy, elevating the risk of potentially inappropriate medication (PIM) use and adverse health outcomes. To address these issues, deprescribing has emerged as a patient-centered approach that considers patients' beliefs and attitudes toward medication and reduces inappropriate polypharmacy in older adults. Our study aims to investigate whether certain chronic medical conditions are associated with older patients' willingness to deprescribe medications. METHODS A cross-sectional study enrolled 192 community-dwelling individuals aged 65 or older taking at least one regular medication. Data included demographics, clinical characteristics, and responses to the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics characterized participants, while multiple binary logistic regression identified associations between chronic medical conditions and willingness to deprescribe. RESULTS Among the participants (median age: 72 years, 65.6% female), 91.6% had multimorbidity. The analysis revealed that willingness to deprescribe significantly increased with the presence of gastric disease (adjusted odds ratio [aOR] = 4.123; 95% CI 1.221, 13.915) and age (aOR = 1.121; 95% CI 1.009, 1.246). Conversely, prostatic pathology (aOR = 0.266; 95% CI 0.077, 0.916), higher scores in the rPATD appropriateness factor (aOR = 0.384; 95% CI 0.190, 0.773), and rPATD concerns about stopping factor (aOR = 0.450; 95% CI 0.229, 0.883) diminished patients' willingness to deprescribe. CONCLUSIONS This study highlights the intricate relationship between older patients' attitudes toward deprescribing and chronic medical conditions. We found that gastric disease was associated with an increased willingness to deprescribe medications, while prostate disease was associated with the opposite effect. Future research should explore how patients with specific diseases or groups of diseases perceive deprescribing of medications general and for specific medications, aiding in the development of targeted interventions.
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Affiliation(s)
- Anabela Pereira
- Centre for Health Technology and Services Research, Associate Laboratory RISE- Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Oscar Ribeiro
- Centre for Health Technology and Services Research, Associate Laboratory RISE- Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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22
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Michael HU, Brouillette MJ, Tamblyn R, Fellows LK, Mayo NE. The association between anticholinergic/sedative burden and physical frailty in people aging with HIV. AIDS 2024; 38:509-519. [PMID: 38051790 DOI: 10.1097/qad.0000000000003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study aimed to estimate the strength of the association between anticholinergic/sedative burden and concurrent physical frailty in people aging with HIV. DESIGN This cross-sectional analysis examined baseline data from 824 adults with a mean age of 53 enrolled in the Positive Brain Health Now study. METHODS Anticholinergic medications were identified using four methods: Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), and the anticholinergic list of the Anticholinergic and Sedative Burden Catalog (ACSBC). Sedatives were identified using the Sedative Load Model (SLM) and the sedative list of the ACSBC. Physical frailty was assessed using a modified Fried Frailty Phenotype (FFP) based on self-report items. Multivariable logistic regression models, adjusted for sociodemographic factors, lifestyle considerations, HIV-related variables, comorbidities, and co-medication use, were used to estimate odds ratios (ORs). RESULTS Anticholinergic burden demonstrated associations with frailty across various methods: total anticholinergic burden (OR range: 1.22-1.32; 95% confidence interval (CI) range: 1.03-1.66), sedative burden (OR range: 1.18-1.24; 95% CI range: 1.02-1.45), high anticholinergic burden (OR range: 2.12-2.74; 95% CI range: 1.03-6.19), and high sedative burden (OR range: 1.94-2.18; 95% CI: 1.01-4.34). CONCLUSION The anticholinergic and sedative burdens may represent modifiable risk factors for frailty in people aging with HIV. Future studies should evaluate the effects of reducing anticholinergic and sedative burdens on frailty outcomes and explore the prognostic value of diverse scoring methods.
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Affiliation(s)
- Henry Ukachukwu Michael
- Division of Experimental Medicine, McGill University
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center
| | - Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine, McGill University
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI
| | - Robyn Tamblyn
- Division of Experimental Medicine, McGill University
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lesley K Fellows
- Department of Neurology & Neurosurgery, Montreal Neurological Institute
| | - Nancy E Mayo
- Division of Experimental Medicine, McGill University
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University
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23
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Gagnon ME, Talbot D, Tremblay F, Desforges K, Sirois C. Polypharmacy and risk of fractures in older adults: A systematic review. J Evid Based Med 2024; 17:145-171. [PMID: 38517979 DOI: 10.1111/jebm.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association. METHODS We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment. RESULTS Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose-response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high. CONCLUSIONS Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results.
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Affiliation(s)
- Marie-Eve Gagnon
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Department of Health Sciences, Université du Québec à Rimouski (UQAR), Rimouski, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
| | - Denis Talbot
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
- Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | | | - Katherine Desforges
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
- Department of Pharmacy, McGill University Health Centre, Montréal, Québec, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
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24
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Ude-Okeleke RC, Aslanpour Z, Dhillon S, Berry R, Bines E, Umaru N. Types, predictors, and consequences of medicines related problems (MRPs) in frail older adults admitted to hospital from primary care - A retrospective cohort study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100402. [PMID: 38235170 PMCID: PMC10792259 DOI: 10.1016/j.rcsop.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Medicines related problems (MRPs) can be common in frail older people due to age-compromised body systems and a propensity to be on multiple drugs concurrently. This group of people can also succumb to a rapid deterioration in health. Thus, it is important to investigate MRPs in frail older people. The objectives of the study were to evaluate prevalence of MRPs, types of MRPs, risk factors and deterioration that can be associated with MRPs in frail older people admitted to an English teaching hospital from primary care. Methods Included in the sample were frail older adults, aged 65 years and over, admitted from primary care. Data was retrieved from the hospital's electronic patient record system, anonymised, and reviewed for MRPs. MRPs which were retrospectively identified at admission were coded with the WHO-ICD10,2016 (World Health Organisation-International Classification of Diseases version 10, 2016). Descriptive and inferential statistics were performed on the data using SPSS Version 25. Primary outcome was the prevalence of MRPs in frail older patients. Secondary outcome was the association of deterioration indicated as fall, delirium, or NEWs ≥3 with presence of MRPs. Results Among the 507 frail older people (≥4 on Rockwood scale) that met criteria for inclusion, 262 (51.8%) were patients with MRPs and 244 (48.2%) without. The Median age of sample as a whole was 85 years (IQR = 80-89). Prevalence of MRPs was 33.28%. Types of MRPs were adverse drug reaction (ADR-20%), non-compliance (9.1%), unintentional poisoning (3.3%) and inappropriate polypharmacy (0.8%). In logistic regression, potentially inappropriate medicines (PIM), social support, number of comorbidities and winter were significant predictors of MRPs. Risk of deteriorating with delirium was two times higher in patients with MRPs than in patients without MRPs, RR 2.613 (95% CI, 1.049 to 6.510). Conclusion MRPs and risks of deterioration associated with MRPs in frail older people can be reduced. This is because factors associated with MRPs can be modified.
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Affiliation(s)
| | - Zoe Aslanpour
- School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Soraya Dhillon
- School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Rachel Berry
- Cambridge University Hospital NHS Foundation Trust, Pharmacy Department, UK
| | - Emma Bines
- Cambridge University Hospital NHS Foundation Trust, Pharmacy Department, UK
| | - Nkiruka Umaru
- School of Life and Medical Sciences, University of Hertfordshire, UK
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25
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Matovelle P, Oliván-Blázquez B, Fraile-Peñaranda I, Turón-Lanuza A, Gallego-Royo A, Casado-Vicente V, Magallón-Botaya R. Polypharmacy in Older Patients: A Three-Year Longitudinal Analysis in Primary Care Settings of Aragón, Spain. Ann Geriatr Med Res 2024; 28:36-45. [PMID: 37994020 PMCID: PMC10982450 DOI: 10.4235/agmr.23.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Challenges of polypharmacy and the impact of coronavirus disease 2019 (COVID-19) pandemic in older patients require further investigation. This retrospective study analyzed the progression of polypharmacy and anticholinergic burden in older patients in a primary care setting before, during, and after the COVID-19 pandemic. METHODS This 3-year cross-sectional study (2019, 2020, and 2021) comprised a dynamic cohort of individuals aged ≥75 years, who attended the Arrabal Primary Care Center in Zaragoza, Spain. Older patients with polypharmacy (≥5 medications) were identified according to their electronic health records. We collected demographic and clinical data, including medication prescriptions, diagnoses, and anticholinergic risks, and performed descriptive and statistical analyses. RESULTS This study included a total of 1,928 patients with a mean age of 83.52±0.30 years. Over the 3-year study period, the mean number of medications prescribed increased, from 9.4 in 2019 to 10.4 in 2021. The prevalence of excessive polypharmacy (≥10 medications) increased from 39% in 2019 to 45% in 2021. The most commonly prescribed drugs were anilides, proton pump inhibitors, benzodiazepine derivatives, and platelet aggregation inhibitors. Women had a higher prevalence of illnesses and anticholinergic drug prescriptions than men. CONCLUSION The results of this study highlighted an upward trend in polypharmacy and excessive polypharmacy among older patients in primary care settings. Future research should focus on optimizing medication management and deprescribing strategies and minimizing the adverse effects of polypharmacy in this population.
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Affiliation(s)
- Priscila Matovelle
- Department of Geriatrics, San Juan de Dios Hospital, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS, RD21/0016/0001), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Irene Fraile-Peñaranda
- Department of Preventive Medicine Unit, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | | | - Alba Gallego-Royo
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Verónica Casado-Vicente
- Family and Community Medicine, University Health Centre Parquesol, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS, RD21/0016/0001), Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
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26
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Lee HG, Arai I, Kwon S. A Herbal Prescription of Insamyangyeongtang as a Therapeutic Agent for Frailty in Elderly: A Narrative Review. Nutrients 2024; 16:721. [PMID: 38474849 DOI: 10.3390/nu16050721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Frailty is a major geriatric syndrome with a multifactorial etiology that induces a decline in multiple physiological and psychological functions. In traditional East Asian medicine (TEAM), qi and blood deficiency clinically represent as fatigue, anemia, anorexia, decreased strength after illness, and weakness, commonly interpretated as frailty. An herbal prescription of Insamyangyeongtang (IYT, Ninjin'yoeito in Japanese, Ren-Shen-Yang-Rong-Tang in Chinese) tonifies qi and blood and has the potential to treat multiple targets caused by qi and blood deficiency. As the population ages and frailty increases, there is an increase in the potential effectiveness of IYT in frailty. This study reviewed relevant clinical trials to provide an updated view on the effect of IYT on frailty. IYT has therapeutic effects on frailty associated with chronic respiratory diseases (e.g., chronic obstructive pulmonary disease) and cognitive impairments (e.g., Alzheimer's disease) and improves respiratory symptoms and cognition. IYT also has therapeutic effects on weight gain, muscle mass, and strength, and improves nutritional status in frail elderly individuals who have decreased muscle mass and strength, loss of appetite, and weight loss. The same effect has been shown in frailty in elderly individuals with rehabilitation treatment and chronic diseases. IYT also improves frailty associated with symptoms such as intractable dizziness and genitourinary symptoms. The beneficial effects of IYT in several diseases could be important for medication replacement, reduction, and prevention of polypharmacy. Based on the results of this review, we suggest that IYT has the potential to be a therapeutic agent against frailty.
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Affiliation(s)
- Han-Gyul Lee
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Ichiro Arai
- Graduate School of Pharmaceutical Sciences, Nihon Pharmaceutical University, Tokyo 113-0034, Japan
| | - Seungwon Kwon
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
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Daimaru K, Osuka Y, Kojima N, Mizukami K, Motokawa K, Iwasaki M, Inagaki H, Miyamae F, Okamura T, Hirano H, Awata S, Sasai H. Associations of polypharmacy with frailty severity and each frailty phenotype in community-dwelling older adults: Itabashi Longitudinal Study on Aging. Geriatr Gerontol Int 2024; 24 Suppl 1:196-201. [PMID: 38169078 DOI: 10.1111/ggi.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
AIM Although polypharmacy and frailty are concerns in older adults, there is limited understanding of their association, particularly regarding frailty severity and its phenotypes within this population. This study aimed to examine the association between polypharmacy and frailty severity or frailty phenotypes in community-dwelling older Japanese adults. METHODS This cross-sectional study included 1021 older adults from the Itabashi Longitudinal Study on Aging. Men accounted for 45.4%, and the mean age (standard deviation) was 77.9 (5.1) years. Participants were classified into frail (n = 67), pre-frail (n = 543), and robust (n = 411) groups using the revised Japanese Cardiovascular Health Study criteria. Polypharmacy was defined as using five or more self-reported prescription drugs. Ordinal and binomial logistic regression analyses examined the association between polypharmacy and frailty severity or frailty phenotypes (weight loss, weakness, exhaustion, slowness, and low activity). These models were adjusted for age, sex, body mass index, number of comorbidities, living status, employment status, years of education, as well as drinking and smoking habits. RESULTS The prevalence of frailty in participants with and without polypharmacy was 10.1% and 5.0%, respectively. Participants with polypharmacy were more likely to have frailty (adjusted odds ratio [95% confidence interval], 1.89 [1.40-2.57]), weight loss (1.81 [1.00-3.27]), weakness (1.50 [1.08-2.09]), and slowness (2.25 [1.29-3.94]) compared with the no-polypharmacy group. CONCLUSIONS Polypharmacy was associated with frailty severity and three frailty phenotypes. Longitudinal studies are required to investigate whether polypharmacy can predict the development and progression of frailty. Geriatr Gerontol Int 2024; 24: 196-201.
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Affiliation(s)
- Kaori Daimaru
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | | | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Inagaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Ruiz Ramos J, Alquézar-Arbé A, Juanes Borrego A, Burillo Putze G, Aguiló S, Jacob J, Fernández C, Llorens P, Quero Espinosa FDB, Gordo Remartinez S, Hernando González R, Moreno Martín M, Sánchez Aroca S, Sara Knabe A, González González R, Carrión Fernández M, Artieda Larrañaga A, Adroher Muñoz M, Hong Cho JU, Escolar Martínez Berganza MT, Gayoso Martín S, Sánchez Sindín G, Silva Penas M, Gómez y Gómez B, Arenos Sambro R, González del Castillo J, Miró Ò. Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project. Ther Adv Drug Saf 2024; 15:20420986241228129. [PMID: 38323189 PMCID: PMC10846059 DOI: 10.1177/20420986241228129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Background Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs. Methods A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project's cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5-9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient's comorbidities, were performed. Results A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71-84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04-1.23) and 1.38 (95% CI: 1.24-1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04-1.35) and 1.36 (95% CI: 1.16-1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89-2.26) and OR 0.89 (95% CI: 0.72-1.12)], respectively. Conclusion Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge.
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Affiliation(s)
- Jesus Ruiz Ramos
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), C/San Quintin 56-58, Barcelona 08025, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Ana Juanes Borrego
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Guillermo Burillo Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Spain
| | - Cesáreo Fernández
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | | | - Sara Sánchez Aroca
- Emergency Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | | | | | - Sara Gayoso Martín
- Emergency Department, Hospital Comarcal El Escorial, San Lorenzo de El Escorial, Spain
| | | | | | | | | | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Mohd Safien A, Ibrahim N, Subramaniam P, Singh DKA, Mat Ludin AF, Chin AV, Shahar S. Prevalence of depression and clinical depressive symptoms in community-dwelling older adults with cognitive frailty. Geriatr Gerontol Int 2024; 24:225-233. [PMID: 38199952 DOI: 10.1111/ggi.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
AIM The present study determines the prevalence of depression and the extent of clinical depression symptoms among community-dwelling older adults with cognitive frailty and its associated factors. METHODS A total of 755 older adults aged ≥60 years were recruited. Their cognitive performance was determined using the Clinical Dementia Rating. Fried's criteria was applied to identify physical frailty, and the Beck Depression Inventory assessed their mental states. RESULTS A total of 39.2% (n = 304) of the participants were classified as cognitive frail. In this cognitive frail subpopulation, 8.6% (n = 26) had clinical depressive symptoms, which were mostly somatic such as disturbance in sleep pattern, work difficulty, fatigue, and lack of appetite. Older adults with cognitive frailty also showed significantly higher depression levels as compared with the noncognitive frail participants (t (622.06) = -3.38; P = 0.001). There are significant associations between depression among older adults with cognitive frailty and multimorbidity (P = 0.009), polypharmacy (P = 0.009), vision problems (P = 0.046), and hearing problems (P = 0.047). The likelihood of older adults with cognitive frailty who experience impairments to their vision and hearing, polypharmacy, and multimorbidity to be depressed also increased by 2, 3, 5, and 7-fold. CONCLUSIONS The majority of the Malaysian community-dwelling older adults were in a good mental state. However, older adults with cognitive frailty are more susceptible to depression due to impairments to their hearing and vision, multimorbidity, and polypharmacy. As common clinical depressive symptoms among older adults with cognitive frailty are mostly somatic, it is crucial for health professionals to recognize these and not to disregard them as only physical illness. Geriatr Gerontol Int 2024; 24: 225-233.
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Affiliation(s)
- A'isyah Mohd Safien
- Clinical Psychology and Behavioral Health Programme & Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Clinical Psychology and Behavioral Health Programme & Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Clinical Psychology and Behavioral Health Programme & Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ai-Vyrn Chin
- Division of Geriatric Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Park JS, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Joung B. All-Cause Death and Major Adverse Events in Atrial Fibrillation with Frailty: Observations from the Korea National Health Insurance Service Data. Rev Cardiovasc Med 2024; 25:52. [PMID: 39077365 PMCID: PMC11263154 DOI: 10.31083/j.rcm2502052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 07/31/2024] Open
Abstract
Background Atrial fibrillation (AF) is an indicator of frailty in old patients. This study aimed to investigate the effect of frailty on the use of oral anticoagulants (OAC) and clinical outcomes in a nationwide cohort of patients with new-onset AF. Methods This study included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort between 2002 and 2009. The Hospital Frailty Risk Score was retrospectively calculated for each patient using all available International Classification of Disease 10th revision diagnostic codes. According to the aggregate score, patients were divided into two groups: the participants without frailty ( < 5 points) and the participants with frailty ( ≥ 5 points). The primary outcome was death from any cause, and the secondary outcomes were cardiovascular death, ischemic stroke, major bleeding, and heart failure admission. Results With up to 7.2 ± 1.5 years of follow-up, 11,953 participants (median age, 67 [interquartile range, 59.5-74.5] years; 7200 [60.2%] males) developed new-onset AF. Among the patients with AF, 3224 (26.9%) had frailty. Frailty was significantly associated with old age, female sex, polypharmacy, and other comorbidities. In patients with AF, frailty was negatively associated with OAC prescription after new-onset AF (p < 0.001). Compared to patients without frailty, patients with frailty had a significantly higher incidence and risk of all-cause death (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.65-3.14), cardiovascular death (HR 2.42, 95% CI 2.10-2.80), ischemic stroke (HR 2.25, 95% CI 2.02-2.51), major bleeding (HR 2.44, 95% CI 2.17-2.73), and heart failure admission (HR 1.29, 95% CI 1.09-1.52). In subgroup analysis, when compared to the non-OAC group, the risks associated with frailty were significantly lower in the OAC group for all-cause death, cardiovascular death, ischemic stroke, and heart failure admission. Conclusions Frailty was negatively associated with the use of OAC and was a predictor of poor prognosis owing to the association of frailty with death, thromboembolic events, bleeding, and heart failure admission. However, OAC use was associated with lower risks related to frailty for all-cause death and major adverse cardiovascular events in patients with AF.
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Affiliation(s)
- Jong Sung Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
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Torres-Atencio I, Carreira MB, Méndez A, Quintero M, Broce A, Oviedo DC, Rangel G, Villarreal AE, Tratner AE, Rodríguez-Araña S, Britton GB. Polypharmacy and Associated Health Outcomes in the PARI-HD Study. J Alzheimers Dis 2024; 98:287-300. [PMID: 38393905 DOI: 10.3233/jad-231001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Background A growing body of evidence points to potential risks associated with polypharmacy (using ≥5 medications) in older adults, but most evidence is derived from studies where racial and ethnic minorities remain underrepresented among research participants. Objective Investigate the association between polypharmacy and cognitive function, subjective health state, frailty, and falls in Hispanic older adults. Methods Panama Aging Research Initiative-Health Disparities (PARI-HD) is a community-based cohort study of older adults free of dementia at baseline. Cognitive function was measured with a neuropsychological test battery. Frailty assessment was based on the Fried criteria. Subjective health state and falls were self-reported. Linear and multinomial logistic regression analyses were used to examine association. Results Baseline evaluations of 468 individuals with a mean age of 69.9 years (SD = 6.8) were included. The median number of medications was 2 (IQR: 1-4); the rate of polypharmacy was 19.7% (95% confidence interval [CI] = 16.1-23.3). Polypharmacy was inversely associated with self-rated overall health (b =-5.89, p < 0.01). Polypharmacy users had 2.3 times higher odds of reporting two or more falls in the previous 12 months (odds ratio [OR] = 2.31, 95% CI = 1.06-5.04). Polypharmacy was independently associated with Fried's criteria for pre-frailty (OR = 2.90, 95% CI = 1.36-5.96) and frailty (OR = 5.14, 95% CI = 1.83-14.42). Polypharmacy was not associated with cognitive impairment. Conclusions These findings illustrate the potential risks associated with polypharmacy among older adults in Panama and may inform interventions to improve health outcomes in this population.
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Affiliation(s)
- Ivonne Torres-Atencio
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Maria B Carreira
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Alondra Méndez
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Maryonelly Quintero
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Adriana Broce
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Diana C Oviedo
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
- Escuela de Psicología, Universidad Católica Santa María La Antigua, Panama City, Panama
| | - Giselle Rangel
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Alcibiades E Villarreal
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Adam E Tratner
- Florida State University, Republic of Panama Campus, Ciudad del Saber, Panama City, Panama
| | - Sofía Rodríguez-Araña
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Gabrielle B Britton
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
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Tanaka K, Kikutani T, Tamura F, Sato S, Komagata Y, Shibasaki I, Tomioka K, Ichikawa Y, Shiobara Y, Sato T, Tohara T. Problems experienced when swallowing solid oral dosage forms in older Japanese patients with dysphagia: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2024; 44:214-220. [PMID: 37029091 DOI: 10.1111/scd.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
AIMS We aimed to assess the difficulty in taking solid oral dosage forms (SODFs) among older people with dysphagia and clarify the relationship between difficulty in swallowing SODFs and swallowing function. METHODS AND RESULTS Outpatients from a dysphagia clinic aged ≥65 years were asked yes-or-no questions about the applicability of eight items regarding difficulty in taking SODFs. Additionally, a videofluorographic swallowing study (VFSS) was performed to assess their swallowing function. The Kruskal-Wallis test and Spearman's rank correlation coefficient were used to analyze the relationship between difficulty in taking SODFs and swallowing function. RESULTS Among the 93 participants, the average number of SODFs consumed was 5.8 ± 3.1. In the questionnaire, the average number of "yes" answers was 2.2 ± 2.2, and 65 patients (71.0%) answered "yes" to at least one question. Additionally, no significant relationship was observed between the perceived difficulty in swallowing SODFs and VFSS findings. CONCLUSION Approximately 70% of participants reported subjective difficulty in taking SODFs, showing that patients uniformly reported perceived difficulty in taking SODFs regardless of actual swallowing function. The results of this study suggest that patients must be questioned thoroughly about their SODFs use, regardless of the objective severity of their dysphagia.
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Affiliation(s)
- Kumi Tanaka
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-city, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-city, Tokyo, Japan
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-city, Tokyo, Japan
| | - Shiho Sato
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Yuka Komagata
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Ikumi Shibasaki
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Kosei Tomioka
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Yoko Ichikawa
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Yuichiro Shiobara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Takanobu Sato
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
| | - Takashi Tohara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Koganei, Tokyo, Japan
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-city, Tokyo, Japan
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Ruiz-Ramos J, Plaza-Diaz A, Roure-i-Nuez C, Fernández-Morató J, González-Bueno J, Barrera-Puigdollers MT, García-Peláez M, Rudi-Sola N, Blázquez-Andión M, San-Martin-Paniello C, Sampol-Mayol C, Juanes-Borrego A. Drug-Related Problems in Elderly Patients Attended to by Emergency Services. J Clin Med 2023; 13:3. [PMID: 38202010 PMCID: PMC10779430 DOI: 10.3390/jcm13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
The progressive aging and comorbidities of the population have led to an increase in the number of patients with polypharmacy attended to in the emergency department. Drug-related problems (DRPs) have become a major cause of admission to these units, as well as a high rate of short-term readmissions. Anticoagulants, antibiotics, antidiabetics, and opioids have been shown to be the most common drugs involved in this issue. Inappropriate polypharmacy has been pointed out as one of the major causes of these emergency visits. Different ways of conducting chronic medication reviews at discharge, primary care coordination, and phone contact with patients at discharge have been shown to reduce new hospitalizations and new emergency room visits due to DRPs, and they are key elements for improving the quality of care provided by emergency services.
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Affiliation(s)
- Jesús Ruiz-Ramos
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Adrián Plaza-Diaz
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Cristina Roure-i-Nuez
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Jordi Fernández-Morató
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Javier González-Bueno
- Pharmacy Department, Hospital Dos de Maig Consorci Sanitari Integral, 08025 Barcelona, Spain; (J.G.-B.); (M.T.B.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic-Universitat Central de Catalunya, 08500 Vic, Spain
| | | | - Milagros García-Peláez
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Nuria Rudi-Sola
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Marta Blázquez-Andión
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
- Emergency Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Carla San-Martin-Paniello
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Caterina Sampol-Mayol
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Ana Juanes-Borrego
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
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Borim FSA, Assumpção DD, Yassuda MS, Costa HTDM, Batistoni SST, Neri AL, Voshaar RCO, Aprahamian I. Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty. EINSTEIN-SAO PAULO 2023; 21:eAO0284. [PMID: 38126546 DOI: 10.31744/einstein_journal/2023ao0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. OBJECTIVE To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. METHODS Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. RESULTS Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. CONCLUSION The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.
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Affiliation(s)
- Flávia Silva Arbex Borim
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Daniela de Assumpção
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Mônica Sanches Yassuda
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Henrique Trajano de Moraes Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging, Department of Internal Medicine, Faculdade de Medicina de Jundiaí, São Paulo, SP, Brazil
| | - Samila Sathler Tavares Batistoni
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anita Liberalesso Neri
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging, Department of Internal Medicine, Faculdade de Medicina de Jundiaí, São Paulo, SP, Brazil
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Trevisan C, Haxhiaj L, Malara A, Abbatecola A, Fedele G, Palmieri A, Leone P, Schiavoni I, Stefanelli P, Maggi S, Sergi G, Volpato S, Incalzi RA, Onder G. Polypharmacy and Antibody Response to SARS-CoV-2 Vaccination in Residents of Long-Term Care Facilities: The GeroCovid Vax Study. Drugs Aging 2023; 40:1133-1141. [PMID: 37938521 DOI: 10.1007/s40266-023-01075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Polypharmacy is common in older adults, particularly among those living in long-term care facilities. This condition represents a marker of clinical complexity and might directly affect the immunological response. However, there are limited data on the association of polypharmacy with vaccine immunogenicity. This study evaluated the immune response to anti-SARS-CoV-2 vaccines in older residents of long-term care facilities as a function of the number of medications used. METHODS In 478 long-term care facility residents participating in the GeroCovid Vax study, we assessed SARS-CoV-2 trimeric S IgG levels through chemiluminescent assays before the vaccination and after 2, 6, and 12 months. A booster dose was administered between 6- and 12-month assessments. Sociodemographic information and data on chronic diseases and medications were derived from medical records. Based on the number of daily medications, residents were classified into the no polypharmacy (zero to four medications), polypharmacy (five to nine medications), and hyperpolypharmacy (ten or more medications) groups. RESULTS In the sample (mean age 82.1 years, 69.2% female), 200 (41.8%) residents were taking five or fewer medications/day (no polypharmacy), 229 (47.9%) had polypharmacy, and 49 (10.3%) had hyperpolypharmacy. Using linear mixed models adjusted for potential confounders, we found that hyperpolypharmacy was associated with a steeper antibody decline after 6 months from the first vaccine dose administration (β = - 0.29, 95% confidence interval - 0.54, - 0.03, p = 0.03) than no polypharmacy, while no significant differences were observed at 12 months. CONCLUSIONS The humoral immune response to SARS-CoV-2 vaccination of older residents showed only slight changes as a function of the number of medications taken. Although it seemed less durable among older residents with hyperpolypharmacy, the booster dose administration equalized such a difference.
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Affiliation(s)
- Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Labjona Haxhiaj
- Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
| | | | - Angela Abbatecola
- Alzheimer's Disease Day Clinic, Azienda Sanitaria Locale, Frosinone, Italy
| | - Giorgio Fedele
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Annapina Palmieri
- Department of Cardiovascular, Endocrine‑Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Pasqualina Leone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Schiavoni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Maggi
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Giuseppe Sergi
- Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Graziano Onder
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
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Pereira A, Ribeiro O, Veríssimo M. Predictors of older patients' willingness to have medications deprescribed: A cross-sectional study. Basic Clin Pharmacol Toxicol 2023; 133:703-717. [PMID: 37070165 DOI: 10.1111/bcpt.13874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Deprescribing is a complex process requiring a patient-centred approach. One frequently expressed deprescribing barrier is patients' attitudes and beliefs towards deprescribing. This study aimed to identify the predictors of patients' willingness to have medications deprescribed. METHODS A cross-sectional study was conducted with community-dwelling patients aged ≥65 who are taking at least one regular medication. Data collection included patients' demographic and clinical characteristics and the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics were used to present the patients' characteristics. Multiple binary logistic regression analysis was performed to identify the predictors of the patients' willingness to have medications deprescribed. RESULTS One hundred ninety-two participants (median age 72 years; 65.6% female) were included. Most (83.33%) were willing to have medications deprescribed, and the predictors were age (adjusted odds ratio [aOR] = 1.136; 95% CI 1.026, 1.258), female sex (aOR = 3.036; 95% CI 1.059, 8.708) and the rPATD concerns about stopping factor (aOR = 0.391; 95% CI 0.203, 0.754). CONCLUSIONS Most patients were willing to have their medications deprescribed if it is recommended by their doctors. Older age and female sex increased the odds of willingness to deprescribe; higher concerns about stopping medications decreased the odds. These findings suggest that addressing patients' concerns about stopping their medicines may contribute to deprescribing success.
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Affiliation(s)
- Anabela Pereira
- Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research at the Associate Laboratory RISE, Health Research Network (CINTESIS@RISE), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Oscar Ribeiro
- Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research at the Associate Laboratory RISE, Health Research Network (CINTESIS@RISE), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Coimbra, Portugal
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Chou YY, Lee YS, Lin CS, Chen JP, Kuo FH, Lin CF, Chen YM, Lin SY. Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk-a real-world analysis. PeerJ 2023; 11:e16262. [PMID: 38025730 PMCID: PMC10668851 DOI: 10.7717/peerj.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. More importantly, the properties of anti-cholinergic drugs contribute various negative effects. This study aimed to investigate the sex difference in the association of polypharmacy, anticholinergic burden, and frailty with mortality. Methods Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment data were collected and the phenotype of frailty was determined by Fried's criteria. Cox regression and the Kaplan-Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks. Results Of the 2,077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score, and greater anticholinergic burden were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. In frail female group, individuals with a higher anticholinergic burden (as indicated by the Anticholinergic Cognitive Burden Scale) from drug usage exhibited an elevated 5-year mortality rate. Conclusions Polypharmacy and greater anticholinergic burden, synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy and anticholinergic burden in the older population.
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Affiliation(s)
- Yin Yi Chou
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu Sheng Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fu-Hsuan Kuo
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Fu Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Fátima Heredia R, Riestra-Ayora JI, Yanes-Díaz J, Thuissard Vasallo IJ, Andreu-Vázquez C, Sanz-Fernández R, Sánchez-Rodríguez C. Cocoa Polyphenols Prevent Age-Related Hearing Loss and Frailty in an In Vivo Model. Antioxidants (Basel) 2023; 12:1994. [PMID: 38001847 PMCID: PMC10669688 DOI: 10.3390/antiox12111994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Age-related hearing loss (ARHL) impairs the quality of life in elderly persons. ARHL is associated with comorbidities, such as depression, falls, or frailty. Frailty syndrome is related to poor health outcomes in old age. ARHL is a potentially modifiable risk factor for frailty. Oxidative stress has been proposed as a key factor underlying the onset and/or development of ARHL and frailty. Cocoa has high levels of polyphenols and provides many health benefits due to its antioxidant properties. Male and female C57Bl/6J mice were randomly assigned to two study groups: animals receiving a cocoa-supplemented diet and the other receiving a standard diet. Then, at the ages of 6, 14, and 22 months, hearing and frailty were measured in all mice. Auditory steady-state responses (ASSR) threshold shifts were measured to different frequencies. The frailty score was based on the "Valencia Score" adapted to the experimental animals. The total antioxidant capacity and total polyphenols in urine samples were also measured. Significant improvements in hearing ability are observed in the cocoa groups at 6, 14, and 22 months compared to the no cocoa group. The cocoa diet significantly retards the development of frailty in mice. Cocoa increases the concentration of polyphenols excreted in the urine, which increases the total antioxidant capacity. In conclusion, cocoa, due to its antioxidant properties, leads to significant protection against ARHL and frailty.
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Affiliation(s)
- Rosalía Fátima Heredia
- Department Clinical Analysis, Hospital Universitario de Getafe, Carretera de Toledo, km 12.500, 28905 Getafe, Madrid, Spain;
| | - Juan I. Riestra-Ayora
- Otolaryngology Department, Hospital Universitario de Getafe, Carretera de Toledo, km 12.500, 28905 Getafe, Madrid, Spain; (J.I.R.-A.); (J.Y.-D.); (R.S.-F.)
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (I.J.T.V.); (C.A.-V.)
| | - Joaquín Yanes-Díaz
- Otolaryngology Department, Hospital Universitario de Getafe, Carretera de Toledo, km 12.500, 28905 Getafe, Madrid, Spain; (J.I.R.-A.); (J.Y.-D.); (R.S.-F.)
| | - Israel John Thuissard Vasallo
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (I.J.T.V.); (C.A.-V.)
| | - Cristina Andreu-Vázquez
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (I.J.T.V.); (C.A.-V.)
| | - Ricardo Sanz-Fernández
- Otolaryngology Department, Hospital Universitario de Getafe, Carretera de Toledo, km 12.500, 28905 Getafe, Madrid, Spain; (J.I.R.-A.); (J.Y.-D.); (R.S.-F.)
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (I.J.T.V.); (C.A.-V.)
| | - Carolina Sánchez-Rodríguez
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (I.J.T.V.); (C.A.-V.)
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Ma W, Wang H, Wen Z, Liu L, Zhang X. Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105087. [PMID: 37311369 DOI: 10.1016/j.archger.2023.105087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. DESIGN Systematic review and meta-analysis. METHODS We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I2 was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies' quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies). RESULTS Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01-1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25-2.43), indicating a bidirectional association between PIM and frailty. CONCLUSIONS PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.
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Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
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Bellanca CM, Augello E, Cantone AF, Di Mauro R, Attaguile GA, Di Giovanni V, Condorelli GA, Di Benedetto G, Cantarella G, Bernardini R. Insight into Risk Factors, Pharmacogenetics/Genomics, and Management of Adverse Drug Reactions in Elderly: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1542. [PMID: 38004408 PMCID: PMC10674329 DOI: 10.3390/ph16111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
The European Medicine Agency (EMA) has defined Adverse Drug Reactions (ADRs) as "a noxious and unintended response to a medicine", not including poisoning, accidental, or intentional overdoses. The ADR occurrence differs based on the approach adopted for defining and detecting them, the characteristics of the population under study, and the research setting. ADRs have a significant impact on morbidity and mortality, particularly among older adults, and represent a financial burden for health services. Between 30% and 60% of ADRs might be predictable and preventable, emerging as a result of inappropriate prescription, drug chemistry inherent toxicity, cell-specific drug toxicity, age- and sex-related anomalies in drug absorption, distribution, metabolism, and elimination (ADME), and drug-drug interactions (DDIs) in combination therapies or when a patient is treated with different drugs for concomitant disorders. This is particularly important in chronic diseases which require long-term treatments. Rapid developments in pharmacogenetics/genomics have improved the understanding of ADRs accompanied by more accurate prescriptions and reduction in unnecessary costs. To alleviate the burden of ADRs, especially in the elderly, interventions focused on pharmaceutical principles, such as medication review and reconciliation, should be integrated into a broader assessment of patients' characteristics, needs, and health priorities. Digital health interventions could offer valuable solutions to assist healthcare professionals in identifying inappropriate prescriptions and promoting patient adherence to pharmacotherapies.
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Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Rosaria Di Mauro
- Dipartimento del Farmaco, ASP Trapani, 91100 Trapani, Italy; (R.D.M.); (V.D.G.)
| | - Giuseppe Antonino Attaguile
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | | | - Guido Attilio Condorelli
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (C.M.B.); (E.A.); (A.F.C.); (G.A.A.); (G.A.C.); (G.C.); (R.B.)
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
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Fortunato M, Lin F, Uddin A, Subah G, Patel R, Feldstein E, Lui A, Dominguez J, Merckling M, Xu P, McIntyre M, Gandhi C, Al-Mufti F. Frailty as a Predictor of Outcomes in Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1498. [PMID: 37891864 PMCID: PMC10605612 DOI: 10.3390/brainsci13101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates that have previously been shown to correlate with frailty. However, the relationship between treatment selection and post-treatment outcomes in frail aSAH patients is not established. We conducted a meta-analysis of the relevant literature in accordance with PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar using "Subarachnoid hemorrhage AND frailty" and "subarachnoid hemorrhage AND frail" as search terms. Data on cohort age, frailty measurements, clinical grading systems, and post-treatment outcomes were extracted. Of 74 studies identified, four studies were included, with a total of 64,668 patients. Percent frailty was 30.4% under a random-effects model in all aSAH patients (p < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model (p < 0.001). There was no significant difference in mortality rate between frail and non-frail aSAH patients, but this analysis only included two studies and should be interpreted cautiously. Age and clinical grading, rather than frailty, independently predicted outcomes and mortality in aSAH patients.
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Affiliation(s)
- Michael Fortunato
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Fangyi Lin
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Anaz Uddin
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Galadu Subah
- Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA (E.F.); (J.D.)
| | - Rohan Patel
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Eric Feldstein
- Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA (E.F.); (J.D.)
| | - Aiden Lui
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Jose Dominguez
- Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA (E.F.); (J.D.)
| | - Matthew Merckling
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Patricia Xu
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
| | - Matthew McIntyre
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Chirag Gandhi
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
- Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA (E.F.); (J.D.)
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA; (M.F.); (F.L.); (A.U.); (R.P.); (A.L.); (P.X.); (C.G.)
- Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA (E.F.); (J.D.)
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Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, Abu Bakar NA, Yau WK, Abu Hassan MR, Rajan P, Tan KC, Ambigapathy S, Vengadasalam P, Zaman Huri S, Arvinder-Singh HS, Thum CC, Chung WM, Ooi JH, Sabki NH, Lee HP, Mohd Shariff SM, Azman MA, Teoh SL, Lee SWH. Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study. J Pharm Policy Pract 2023; 16:122. [PMID: 37858273 PMCID: PMC10588247 DOI: 10.1186/s40545-023-00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source. AIM To develop a list of medications to facilitate appropriate prescribing among older adults. METHODS A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians. RESULTS The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains. CONCLUSIONS The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.
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Affiliation(s)
- Chee Tao Chang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia.
| | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
- Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Wee Kooi Cheah
- Department of Medicine, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Alan Swee Hock Ch'ng
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - Chiann Ni Thiam
- Department of Medicine, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Nor Azlina Abu Bakar
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Weng Keong Yau
- Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Kar Choon Tan
- Hepatological Department, Hospital Selayang, Ministry of Health Malaysia, Selayang, Malaysia
| | | | | | - Surina Zaman Huri
- Psychiatry Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - H S Arvinder-Singh
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
- Department of Community Medicine, Hospital University Kebangsaan Malaysia, Bangi, Malaysia
| | - Chern Choong Thum
- Department of Psychiatry, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Malaysia
| | - Wai Mun Chung
- Emergency and Trauma Department, Hospital Taiping, Taiping, Malaysia
| | - Jun How Ooi
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor Hamizah Sabki
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Hooi Peng Lee
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Muhammad Azuan Azman
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
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Uematsu T, Kawakami Y, Nojiri S, Saito T, Irie Y, Kasai T, Hiratsuka Y, Ishijima M, Kuroki M, Daida H, Nishizaki Y. Association between number of medications and hip fractures in Japanese elderly using conditional logistic LASSO regression. Sci Rep 2023; 13:16831. [PMID: 37803071 PMCID: PMC10558461 DOI: 10.1038/s41598-023-43876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
To examine the association between hip fracture and associated factors, including polypharmacy, and develop an optimal predictive model, we conducted a population-based matched case-control study using the health insurance claims data on hip fracture among Japanese patients. We included 34,717 hospitalized Japanese patients aged ≥ 65 years with hip fracture and 34,717 age- and sex- matched controls who were matched 1:1. This study included 69,434 participants. Overall, 16 variable comorbidities and 60 variable concomitant medications were used as explanatory variables. The participants were added to early elderly and late elderly categories for further analysis. The odds ratio of hip fracture increased with the number of medications only in the early elderly. AUC was highest for early elderly (AUC, 0.74, 95% CI 0.72-0.76). Use of anti-Parkinson's drugs had the largest coefficient and was the most influential variable in many categories. This study confirmed the association between risk factors, including polypharmacy and hip fracture. The risk of hip fracture increased with an increase in medication number taken by the early elderly and showed good predictive accuracy, whereas there was no such association in the late elderly. Therefore, the early elderly in Japan should be an active target population for hip fracture prevention.
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Affiliation(s)
- Takuya Uematsu
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Hospital Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yuta Kawakami
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
- Graduate School of Engineering Science, Yokohama National University, Kanagawa, Japan
| | - Shuko Nojiri
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
| | - Tomoyuki Saito
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Yoshiki Irie
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
- Graduate School of Engineering Science, Tokyo University of Science, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopedics and Motor Organ, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Manabu Kuroki
- Graduate School of Engineering Science, Yokohama National University, Kanagawa, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
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Lyne S. Benefits of deprescribing for older people with frailty and polypharmacy: part one. Nurs Older People 2023; 35:35-41. [PMID: 37670533 DOI: 10.7748/nop.2023.e1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.
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Affiliation(s)
- Sue Lyne
- East Sussex Healthcare NHS Trust, East Sussex, England
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Derhem B, Özsari S. Frailty and Polypharmacy in Primary Care. Biol Res Nurs 2023; 25:658-663. [PMID: 37231714 DOI: 10.1177/10998004231179485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The Clinical Frailty Scale (CFS) is a clinical judgement-based frailty tool developed from the Canadian Study of Health and Aging. Many studies on the measurement of frailty and its effect on clinical outcomes have been conducted on patients hospitalized, especially in intensive care units. The purpose of this study is to examine the relationship between polypharmacy and frailty on outpatient older adult patients in primary care. MATERIALS AND METHOD This cross-sectional study included 298 patients who were aged ≥65 years and admitted to Yenimahalle Family Health Center between May-2022 and July-2022. Frailty was evaluated by using CFS. Polypharmacy was defined as five medications or more and "excessive polypharmacy" as 10 medications or more. The medications below five are grouped as "no polypharmacy". RESULTS There was a statistically significance between age groups, gender, smoking status, marital status, polypharmacy status, and FS (p = .003 and η2: .20; p < .001 and Cohen d: .80; p = .018 and Cohen d: .35; p < .001 and Cohen d: 1.10 and p < .001 and η2: 1.45 respectively). A strong, positive correlation was found between polypharmacy and the frailty score. CONCLUSION Polypharmacy, especially excessive polypharmacy, may be a promising adjunct to frailty in identifying older patients whose health is more likely to worsen. Providers in primary care should also consider frailty when prescribing drugs.
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Affiliation(s)
- Baki Derhem
- General Directorate of Public Health, The Ministry of Health of Turkey, Ankara, Turkey
| | - Süleyman Özsari
- Family Medicine Department, Bolu Abant İzzet Baysal University Medical Faculty, Bolu, Turkey
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Schipa C, Luca E, Ripa M, Sollazzi L, Aceto P. Preoperative evaluation of the elderly patient. Saudi J Anaesth 2023; 17:482-490. [PMID: 37779566 PMCID: PMC10540990 DOI: 10.4103/sja.sja_613_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 10/03/2023] Open
Abstract
Nowadays, the pre-operative evaluation of older patients is a critical step in the decision-making process. Clinical assessment and care planning should be considered a whole process rather than separate issues. Clinicians should use validated tools for pre-operative risk assessment of older patients to minimize surgery-related morbidity and mortality and enhance care quality. Traditional pre-operative consultation often fails to capture the pathophysiological and functional profiles of older patients. The elderly's pre-operative evaluation should be focused on determining the patient's functional reserve and reducing any possible peri-operative risk. Therefore, older adults may benefit from the Comprehensive Geriatric Assessment (CGA) that allows clinicians to evaluate several aspects of elderly life, such as depression and cognitive disorders, social status, multi-morbidity, frailty, geriatric syndromes, nutritional status, and polypharmacy. Despite the recognized challenges in applying the CGA, it may provide a realistic risk assessment for post-operative complications and suggest a tailored peri-operative treatment plan for older adults, including pre-operative optimization strategies. The older adults' pre-operative examination should not be considered a mere stand-alone, that is, an independent stage of the surgical pathway, but rather a vital step toward a personalized therapeutic approach that may involve professionals from different clinical fields. The aim of this review is to revise the evidence from the literature and highlight the most important items to be implemented in the pre-operative evaluation process in order to identify better all elderly patients' needs.
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Affiliation(s)
- Chiara Schipa
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Ersilia Luca
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Matteo Ripa
- Università Cattolica del Sacro Cuore, Rome
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liliana Sollazzi
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Paola Aceto
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
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Marcozzi S, Bigossi G, Giuliani ME, Lai G, Giacconi R, Piacenza F, Malavolta M. Spreading Senescent Cells' Burden and Emerging Therapeutic Targets for Frailty. Cells 2023; 12:2287. [PMID: 37759509 PMCID: PMC10528263 DOI: 10.3390/cells12182287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The spreading of senescent cells' burden holds profound implications for frailty, prompting the exploration of novel therapeutic targets. In this perspective review, we delve into the intricate mechanisms underlying senescent cell spreading, its implications for frailty, and its therapeutic development. We have focused our attention on the emerging age-related biological factors, such as microbiome and virome alterations, elucidating their significant contribution to the loss of control over the accumulation rate of senescent cells, particularly affecting key frailty domains, the musculoskeletal system and cerebral functions. We believe that gaining an understanding of these mechanisms could not only aid in elucidating the involvement of cellular senescence in frailty but also offer diverse therapeutic possibilities, potentially advancing the future development of tailored interventions for these highly diverse patients.
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Affiliation(s)
- Serena Marcozzi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy
| | - Giorgia Bigossi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Maria Elisa Giuliani
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Giovanni Lai
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
| | - Marco Malavolta
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy; (S.M.); (G.B.); (M.E.G.); (R.G.); (F.P.)
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Roncal-Belzunce V, Cedeño-Veloz BA, Elcano RSM, Gutiérrez-Valencia M, Izquieta VR, Guruceaga-Eguillor I, Marín-Epelde I, Echeverria-Beistegui I, Sánchez-Latorre M, Galbete A, Garaioa-Aramburu K, Martínez-Velilla N. Cognitive and functional trajectories in geriatric outpatients after a pharmacologic multidisciplinary intervention: A study protocol. Rev Esp Geriatr Gerontol 2023; 58:101386. [PMID: 37523939 DOI: 10.1016/j.regg.2023.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/14/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. METHODS A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients' functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR - Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients' quality of life, rate of falling, and use of healthcare resources. DISCUSSION We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. TRIAL REGISTRATION ClinicalTrials.gov: NCT05408598 (March 1, 2022).
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Affiliation(s)
- Victoria Roncal-Belzunce
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain.
| | - Bernardo Abel Cedeño-Veloz
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Itxaso Marín-Epelde
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | - Iciar Echeverria-Beistegui
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain
| | | | - Arkaitz Galbete
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain
| | | | - Nicolás Martínez-Velilla
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
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Gómez-Gómez C, Moya-Molina MÁ, Tey-Aguilera MJ, Flores-Azofra J, González-Caballero JL. Baseline Profiles of Drug Prescriptions Prior to Diagnosis of Mild Cognitive Impairment (MCI) Obtained by Latent Class Analysis (LCA), and Assessment of Their Association with Conversion to Dementia. Healthcare (Basel) 2023; 11:2219. [PMID: 37570459 PMCID: PMC10419237 DOI: 10.3390/healthcare11152219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Polypharmacy has been linked to cognitive decline. However, interventions targeting modifiable risk factors, some of which are targets of the most commonly used drugs, could reduce the prevalence of dementia. Our aim was to determine the drug prescription regimen at baseline, prior to the diagnosis of mild cognitive impairment (MCI), and its possible association with progression to dementia. Data were collected from the electronic medical records of 342 MCI outpatients diagnosed during 2006-2017 at their first neurology consultation. We followed the classical three-step method of statistical analysis, starting with a Latent Class Analysis (LCA) to discover subgroups of drug prescription probability. Half of the patients were under polypharmacy (≥5 drugs), 17.5% had no recorded medication, 33.3% progressed to dementia (94.7% in ≤5 years), and 84.1% of them to Alzheimer's disease (AD). According to the LCA and based on 20 therapeutic indicators obtained from 240 substances and regrouped according the Anatomical Therapeutic Chemical Classification, we identified a four-profile model: (1) low (35.7% of patients); (2) mixed (28.7%); (3) cardio-metabolic (19.3%); and (4) psychotropic (16.4%). The binomial regression logistic model showed that profiles 2 and 3 (and 4 for AD), with a higher drug prescription conditioned probability against classic risk factors, were protective than profile 1 (OR = 0.421, p = 0.004; OR = 0.278, p = 0.000; OR = 0.457, p = 0.040, respectively), despite polypharmacy being significant in profiles 2 and 3 (mean > 7 drugs) vs. profile 1 (1.4 ± 1.6) (p = 0.000). Patients in the latter group were not significantly older, although being aged 65-79 years old quadrupled (OR = 4.217, p = 000) and being >79 tripled (OR = 2.945, p = 0.010) the conversion risk compared to patients <65 years old. According to the proposed analytical model, profiling the heterogeneous association of risk factors, which were taken prior to diagnosis, could be explored as an indicator of prior care and a predictor of conversion to dementia.
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Affiliation(s)
- Carmen Gómez-Gómez
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Miguel Ángel Moya-Molina
- Department of Neurology, Hospital Universitario Puerta del Mar (HUPM), University of Cadiz, 11009 Cádiz, Spain
| | - Manuel Jesús Tey-Aguilera
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Jorge Flores-Azofra
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
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Irie N, Muramoto N, Shirakawa T, China T, Kawano H, Isotani S, Horie S. High prevalence of frailty in patients with lower urinary tract symptoms. Geriatr Gerontol Int 2023; 23:609-615. [PMID: 37528501 DOI: 10.1111/ggi.14633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023]
Abstract
AIM Older adults are more likely to be frail and have a high prevalence of urological diseases such as lower urinary tract symptoms (LUTS). The purpose of this study was to clarify the prevalence and characteristics of comorbid frailty in older patients with urological diseases. METHODS We retrospectively reviewed the medical records of 970 patient who visited the Department of Urology, Juntendo University Hospital between October 2015 and October 2016. Patients were selected who were 65 years of age or older and were being evaluated by the Kihon Checklist (KCL) to assess frailty. We examined the prevalence of comorbid frailty in urological diseases, identified factors associated with comorbid frailty in urological diseases, and examined KCL scores in urological diseases with a high prevalence of frailty. RESULTS A total of 405 participants were included. Of these, 21.7% were frail, 20.5% were pre-frail, and 57.8% were robust. LUTS, overactive bladder, and neurogenic bladder showed a statistically significant relationship with comorbid frailty, with high frailty prevalence rates of 44/140 (31.4%), 19/36 (52.8%), and 4/6 (66.7%), respectively. Factors related to the comorbid frailty according to multivariate analysis were female sex (P = 0.001), older age (P < 0.001), and LUTS (P < 0.033). Of the KCL subscale scores, instrumental activities of daily living (P = 0.008), physical function (P < 0.001), oral function (P = 0.008), housebound (P = 0.009), and depression (P = 0.034) were higher in LUTS patients than in non-LUTS patients. CONCLUSIONS Among patients with urological diseases, those with LUTS were found to have a high prevalence of frailty. Geriatr Gerontol Int 2023; 23: 609-615.
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Affiliation(s)
- Naohiro Irie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Nobuhito Muramoto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Department of Advanced Informatics for Genetic Diseases, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Department of Advanced Informatics for Genetic Diseases, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Department of Digital Therapeutics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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